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SCTC December 2016 Digest

 

 

 

December 19, 2016

 

Dear NCI SCTC Research Initiative partners,

 

Welcome to the National Cancer Institute State and Community Tobacco Control (SCTC) Research Initiative December 2016 digest.

 

As a reminder, the purpose of this digest is to inform key tobacco control partners such as yourself of our work so that you can in turn share the information relevant to your constituents through your normal means of communication. If you see any released publications or products that could be useful for your constituents, feel free to share them in your newsletters. Additionally, if you see any upcoming publications or briefs with which you would like to coordinate program activities or news releases, do not hesitate to get in touch with us at the Coordinating Center or the listed authors and principal investigators.

 

We welcome feedback on ways we can improve the format, content, and delivery of this digest to make it easier to use. Please send any feedback to SCTC-Coordinating-Center@rti.org.

 

Thank for your support of the NCI SCTC Research Initiative.

 

Sincerely,

 

The State and Community Tobacco Control Research Initiative Coordinating Center

 

PI: Matthew C. Farrelly, PhD

Co-PIs: Carol Schmitt, PhD, and Todd Rogers, PhD

 

 

New Publications

D’Angelo, H., Ammerman, A., Gordon-Larsen, P., Linnan, L., Lytle, L., & Ribisl, K. M. (2016). Small food store retailers’ willingness to implement healthy store strategies in rural North Carolina. Journal of Community Health , 1-7.

 

Overview

This study assessed willingness of small food store retailers to implement healthy store strategies to increase the availability, display, and promotion of healthy foods and decrease the availability, display, and promotion of tobacco products. Researchers conducted store observations and interviews with 55 small food store retailers in three North Carolina counties.

Value added

Most healthy stores efforts in the United States have focused on urban areas; this study adds to the literature by assessing the willingness of retailers in rural areas to implement these strategies.

Highlights

  • A higher percentage of stores had displays near the register and signs/ads and promotions for unhealthy foods and tobacco products compared with healthy foods. For example, almost all stores displayed at least one unhealthy food or beverage and tobacco product near the register, while only a little more than a third of stores displayed health food near the register.
  • All stores sold low-calorie beverages, sugar-sweetened beverages, candy, and cigarettes. Nearly all sold smokeless tobacco and cigars/cigarillos. Only 30.2% of stores sold fresh fruits, and 9.4% sold fresh vegetables.
  • Although retailers expressed willingness to implement strategies to increase healthy food availability and promotion, nearly all retailers were unwilling to reduce the availability of tobacco products or marketing.
  • Some retailers were willing to remove tobacco ads/signs outside the store (15%), fewer were willing to move products away from the register (5.8%), and almost none were willing to stop selling tobacco products completely (1.9%).

Implications

Small food stores may depend on selling tobacco products for economic reasons, such as industry incentives. Local tobacco control policies that restrict tobacco product sales and marketing at the point of sale may be more effective than voluntary policies, or could be included with healthy food ordinances.

 

Henriksen, L., Schleicher, N. C., Barker, D. C., Liu, Y., & Chaloupka, F. J. (2016). Prices for tobacco and nontobacco products in pharmacies versus other stores: Results from retail marketing surveillance in California and in the United States. American Journal of Public Health, 106(10), 1858-1864. doi: 10.2105/AJPH.2016.303306. PMID: 27552272

 

Overview

Price is an important determinant of tobacco use, and this study investigates variation of cigarette prices by store type and neighborhood demography in two large representative samples of tobacco retailers. Prices of Marlboro, Newport menthol, and bottled water were recorded in a random sample of licensed tobacco retailers (n = 579) in California in 2014. Comparable data from retailers in school enrollment zones (n = 2,603) were collected in 2012 for representative samples of 8th-, 10th-, and 12th-graders in the United States.

Value added

 

This study is the first to compare the price of cigarettes in pharmacies versus all other tobacco retailers, to report on the cheapest pack regardless of brand, and to include price of a nontobacco product. Two large representative samples of tobacco retailers is an additional strength.

Highlights

  • Compared to other store types, pharmacies charged less for cigarettes and more for bottled water. For example, the price of Marlboro in the California sample was significantly higher in convenience stores (+ $0.32), liquor stores (+ $0.37), small grocery stores (+ $0.48), and supermarkets (+ $1.12) compared to pharmacies. A similar pattern was observed in the U.S. sample and across other cigarette prices.
  • In both samples, pharmacies charged more for bottled water than other types of stores. The average difference ranged from + $0.13 to +$0.39.
  • Neighborhood race/ethnicity, income, and age were associated with the price of cigarettes, but not with bottled water. In both the California and U.S. samples, Newport (the most popular brand of menthol cigarettes) cost less in neighborhoods with a higher proportion of African Americans. In both samples, the cheapest cigarette pack cost less in neighborhoods with lower median household incomes.
  • Marlboro and the cheapest cigarette pack regardless of brand cost less in neighborhoods with a higher proportion of school-age residents, but this pattern was only observed in California.

Implications

 

State and local efforts to establish tobacco-free pharmacies policies would eliminate a significant source of cheaper cigarettes. The evidence about lower prices for the most popular brand of menthol cigarettes in African American neighborhoods is not new, but consistent results from two large representative samples inform policies that would promote health equity.

 

Ribisl, K. M., Luke, D. A., Bohannon, D. L., Sorg, A. A., & Moreland-Russell, S. (2016). Reducing disparities in tobacco retailer density by banning tobacco product sales near schools. Nicotine & Tobacco Research (2016), ntw185.

 

Overview

This study explored whether a policy of banning tobacco product retailers from operating within 1,000 feet of schools could reduce socioeconomic and racial/ethnic disparities present in tobacco retailer density. In this study, all tobacco retailers in Missouri and New York were geocoded and linked with Census tract characteristics to test the potential impact of a proximity policy.

Value added

This study provides the estimated impacts of a policy that bans tobacco product sales near schools and identifies the pro-equity impact such a policy could have.

Highlights

Pre-ban:

  • In both Missouri and New York, the mean distance from a school to the nearest retailer was lower in the lowest income bracket compared to all other income brackets.
  • Neighborhoods with a higher proportion of African Americans had greater concentration of stores than neighborhoods with a low proportion of African Americans.

Post-ban:

  • If implemented, a tobacco retailer ban within 1,000 feet of schools would reduce or eliminate most disparities in tobacco retailer density that largely impact African American neighborhoods, Hispanic neighborhoods, and lower income areas.

Implications

Jurisdictions with tobacco retailer licensing should consider banning tobacco product sales near schools as a way to reduce disparities in the number and density of tobacco retailers.

 

Ribisl, K. M., Luke, D. A., & Henriksen, L. (2016). The case for a concerted push to reduce place-based disparities in smoking-related cancers. JAMA Internal Medicine, 176(12), 1799-1800.

 

Overview

This commentary builds on an article that identifies substantial disparities in the smoking-attributable cancer mortality among U.S. states. The original article suggests that the disparities are driven by uneven levels of funding for state tobacco programs and inequitable distribution of strong tobacco control policies from state to state, rather than demographic differences. To explore further, this commentary compares state tobacco control policies and funding in the 10 states with the highest and lowest rates of smoking-attributable cancer mortality.

Value added

Authors offer potential strategies that states, localities, federal organizations, and advocacy organizations can pursue to promote health equity.

Highlights

  • States with weaker tobacco control policy environments (e.g., lower cigarette excise taxes, no comprehensive smoke-free policies, modest program spending) had the highest rates of smoking-attributable cancer mortalities.
  • Progress toward increasing cigarette excise taxes and promoting smoke-free air policies has recently stagnated, which raises concerns that disparities among states will worsen.
  • The tobacco industry contributes to the lack of progress by putting forth significant resources to erode legislative and public support for tobacco control policies.
  • To combat state inaction, localities can continue to push policy innovation at the local level. To address disparities, federal organizations can consider providing greater tobacco control funding to states with greater smoking-attributable mortalities, and advocacy organizations can consider funding tobacco control initiatives in high-risk states.

Implications

Federal, state, and local policies are needed to reduce place-based disparities among states. Tobacco control practitioners and policymakers must make a concerted effort to “unstick” stalled states to eliminate disparities in smoking prevalence and tobacco-related disease and mortality.

 

Savas, L. S., Mullen, P. D., Hovell, M. F., Escoffrey, C., Fernandez, M. E., Jones, J. A., Cavazos, J., Gutierrez Monroy, J. A. A., & Kegler, M. C. (2016). A qualitative study among Mexican Americans to understand factors influencing the adoption and enforcement of home smoking bans. Nicotine & Tobacco Research (2016): ntw270.

 

Overview

The Smoke Free Homes program―a brief English language intervention―has been shown to be effective in increasing home smoking bans. This qualitative study explores factors determining adoption and enforcement of smoking bans in Mexican American households. Participants were Mexican American smokers and nonsmokers living with at least one smoker in Houston and San Diego.

Value added

Few smoke-free home interventions target Mexican American households, and those that do largely target families with children who have health problems. This study provides cultural and linguistic considerations for adapting the Smoke Free Homes program for this population.

Highlights

  • Although participants reported many barriers and facilitators in common with other populations, specific themes related to Mexican American cultural beliefs and norms emerged in the interviews that may affect adoption and enforcement of home smoking bans:
    • Simpatia emphasizes agreeability and courtesy. A desire to accommodate other family members and visitors was commonly cited as a reason to allow smoking in the home. A culturally relevant strategy to address this challenge is to adopt passive ways of asking visitors not to smoke, such as posting stickers and signs in the home. Household members would avoid social discomfort caused by directly asking visitors to smoke outside.
    • Respeto emphasizes high respect for the elderly, visitors, and heads of household. In multigenerational households, a young nonsmoker may not feel empowered to challenge an older smoker. Several women in this study expressed passivity with regard to male partners living in the home, reflecting traditional gender roles. Cultural-specific scenarios is a way to help address this issue by providing strategies of how to navigate difficult discussions.
    • Familismo describes the importance of family attachment and needs over individual needs. Adults cited protection of children’s health as a reason for home smoking bans, though familismo is sometimes circumvented by simpatia. Use of stickers and signs with messages emphasizing familismo could be effective by further communicating the SHS risks to visitors of the home.

Implications

 

Understanding the influence of Mexican American cultural norms and values can help public health practitioners tailor interventions to address the needs of this population. Population-specific cultural and language adaptations to household smoking ban interventions may increase their reach and effectiveness.

 

Schleicher, N. C., Johnson, T. O., Fortmann, S. P., & Henriksen, L. (2016). Tobacco outlet density near home and school: Associations with smoking and norms among US teens. Preventive Medicine, 91, 287-293. doi: 10.1016/j.ypmed.2016.08.027.

 

Overview

This study examined whether living or going to school in neighborhoods with higher tobacco outlet density is associated with greater odds of cigarette smoking among teens and with perceptions of greater smoking prevalence and peer approval. Survey data from teens and parents from an online panel representative of U.S. households were matched with environmental data about their home and school neighborhoods.

Value added

This study is among the first to provide evidence that more tobacco outlets in the environment serve to normalize smoking. The results from this representative U.S. sample also confirm previous findings from a California study suggesting that tobacco outlet density near teens’ homes appears to matter more than density near schools.

Highlights

  • Approximately 4 in 10 U.S. teens ages 13-16 lived within walking distance (half a mile) of at least one tobacco outlet, 3 in 4 attended school within walking distance of at least one tobacco outlet, and nearly half attended school within 1,000 feet of at least one tobacco outlet.
  • African American youth were more than twice as likely as white youth to live near a tobacco outlet even after adjusting for household income.
  • Higher odds of ever smoking were associated with higher tobacco outlet density near homes but not near schools.
  • Higher tobacco outlet density within walking distance of home was also associated with teens’ perceptions that more adults smoked.

Implications

Local policies to limit tobacco outlet density typically focus on limiting proximity to schools. Results of this study suggest that smoking prevention would benefit from policies that aim to reduce tobacco outlet density everywhere, not exclusively near schools.

 

Shi, Y., Cummins, S. E., & Zhu, S.-H. (2016). Use of electronic cigarettes in smoke-free environments. Tobacco Control (2016): tobaccocontrol-2016.

 

Overview

This study recruited participants from a nationally representative adult web panel in 2014 and examined the use of electronic cigarettes in smoke-free environments by current e-cigarette users and related attitudes and perceptions.

Value added

This study is the first to provide a population estimate of e-cigarette use in places where smoking is not allowed. This study provides empirical data about how many e-cigarette users have vaped in smoke-free environments and who these users are.

Highlights

  • Most current e-cigarette users (59.5%) report having vaped where smoking was not allowed.
  • Young adults ages 18-29 were most likely (74.2%) to vape where smoking was not allowed. Older adults were significantly less than likely to have used e-cigarettes in smoke-free environment relative to the younger age group.
  • Daily e-cigarette users had higher odds of having vaped in smoke-free environments than nondaily users.
  • Service venues, such as bars, restaurants, lounges, or clubs, were the most common place of first use of e-cigarettes in a smoke-free environment.
  • Sixty-two percent of e-cigarette users disagreed that e-cigarettes are harmful, and 83% disagreed that secondhand vapor is harmful to bystanders.
  • Few e-cigarette users (2.5%) report receiving negative reactions from other people when they vape in a smoke-free environment.

Implications

The majority of e-cigarette users perceive their use as acceptable in smoke-free areas. Most e-cigarette users, particularly young adults, do not consider smoke-free laws applicable to e-cigarettes. Laws that restrict e-cigarette use need to be explicit to minimize secondhand exposure to e-cigarette emissions.

 

Williams, R. S., Stollings, J. H., Bundy, Ł., Haardörfer, R., Kreuter, M. W., Dolan Mullen, P., Hovell, M., Morris, M., & Kegler, M. C. (2016). A minimal intervention to promote smoke-free homes among 2-1-1 callers: North Carolina randomized effectiveness trial. PloS one 11.11 (2016): e0165086.

 

Overview

The Smoke Free Homes program is a minimally intensive program with three mailings and a single counseling telephone call, implemented in partnership with 2-1-1 social services information and referral systems. A previous efficacy trial in Georgia found that this program was successful in promoting home smoking bans. This study tested the intervention in North Carolina and examined the extent to which delivery of the intervention by 2-1-1 staff, rather than university researchers, had an effect on the adoption of home smoking bans.

Value added

This study substantiates the program’s effectiveness and generalizability in another setting―North Carolina. Further, this study indicates the recruitment and delivery of the program by 2-1-1 information and referral specialists is just as effective as recruitment and delivery of the program by university personnel.

Highlights

  • Participants in intervention households who participated in the Smoke Free Homes program were more likely than control participants to report a full household smoking ban after 3 months and 6 months.
  • Participants in intervention households had significantly less self-reported secondhand smoke exposure compared to those in the control group and were more likely to have a car smoking ban.
  • Smokers in intervention households reported more quit attempts and smoked fewer cigarettes per day compared to smokers in the control group.

Implications

This paper describes an innovative program that was successful in promoting home smoking bans in low-income households. This study shows that the intervention can be successful in real-world settings and that 2-1-1 Call Centers can be an effective partner in tobacco control.

 

 

New Products

Standardized Tobacco Assessment for Retail Settings (STARS)

Overview

The PhenX Toolkit (https://www.phenxtoolkit.org/) is an online catalog of standard measures for use in biomedical research. The PhenX Tobacco Regulatory Research Panel recently released the Tobacco Regulatory Research (TRR) Core Collection, a set of 25 consensus measures in tobacco regulatory research. The Standardized Tobacco Assessment for Retail Settings (STARS) instrument was released along with these measures and is now available through this online platform (https://www.phenxtoolkit.org/index.php?pageLink=browse.protocols&id=741000).

Value added

Using established consensus measures advances tobacco regulatory science by enabling collaboration among investigators, enhancing cross-study analysis, and allowing for future data comparison, validation, and replication. Inclusion of the STARS instrument in the toolkit will promote use of the instrument by investigators.

Purpose

The purpose of the STARS instrument is to conduct systematic observations of tobacco marketing at the point of sale to assess product availability, promotion, and price.